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Master Thesis

Étude rétrospective multicentrique des facteurs de risque d’échec précoce de la myotomie perorale endoscopique (POEM) dans l’achalasie

Abstract : Per oral endoscopic myotomy (POEM) for the treatment of achalasia now has widely demonstrated efficacy and is often proposed as first-line treatment. Little is known about the predictive factors for early failure of this procedure; the objective of our study was to identify them. It was a retrospective study carried out in 5 French centers. In a first step, age, gender and type of achalasia were collected for each patient, as well as the effectiveness of the treatment at 3 to 6 months. In a second step, patients with early failure were matched to patients with early success, in order to identify other factors predictive of failure. The matching criteria were center, patient gender, type of achalasia, and age (+/- 10 years). The total population consisted of 733 patients, including 69 early failure patients (9.4%). Predictors of failure in the total population were age less than or equal to 45 years, with an odds ratio of 1.9 (p=0.013), type of achalasia with an odds ratio of 2.5 in case of type I or III (p=0.001), existence of a serious complication during the procedure with an OR of 3.0 (p=0.019). The case-control analysis revealed an additional risk factor in multivariate analysis, the pre-POEM Eckardt score, with an increased risk of failure as the Eckardt score increased (p<0.001). Among the determinants of the Eckardt score, only the intensity of retrosternal pain was also significantly associated with the early failure rate. In our study, the occurrence of early failure was not significantly associated with patient gender, operator experience, or prior treatment of achalasia.
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https://dumas.ccsd.cnrs.fr/dumas-03428681
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Submitted on : Monday, November 15, 2021 - 11:30:04 AM
Last modification on : Friday, December 17, 2021 - 3:47:07 AM
Long-term archiving on: : Wednesday, February 16, 2022 - 8:12:36 PM

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  • HAL Id : dumas-03428681, version 1

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Blandine Vauquelin. Étude rétrospective multicentrique des facteurs de risque d’échec précoce de la myotomie perorale endoscopique (POEM) dans l’achalasie. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03428681⟩

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